Amal A Wanigatunga1,2, Alice L Sternberg1, Amanda L Blackford3, Yurun Cai1, Christine M Mitchell1,4, David L Roth2,5, Edgar R Miller4,6, Sarah L Szanton2,7, Stephen P Juraschek8, Erin D Michos4,9, Jennifer A Schrack1,2, Lawrence J Appel1,4,6. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 2. Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA. 3. Division of Biostatistics and Bioinformatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 4. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA. 5. Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 6. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 7. Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, USA. 8. Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, Massachusetts, USA. 9. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND/ OBJECTIVES: To assess whether vitamin D supplementation prevents specific fall subtypes and sequelae (e.g., fracture). DESIGN: Secondary analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You)-a response-adaptive, randomized clinical trial. SETTING: Two community-based research units. PARTICIPANTS: Six hundred and eighty-eight participants ≥70 years old with elevated fall risk and baseline serum 25-hydroxyvitamin D levels of 10-29 ng/ml. INTERVENTION: 200 IU/day (control), 1000 IU/day, 2000 IU/day, or 4000 IU/day of vitamin D3. MEASUREMENTS: Outcomes included repeat falls and falls that were consequential, were injurious, resulted in emergency care, resulted in fracture, and occurred either indoors or outdoors. RESULTS: After adjustment for multiple comparisons, the risk of fall-related fracture was greater in the pooled higher doses (≥1000 IU/day) group compared with the control (hazard ratio [HR] = 2.66; 95% confidence interval [CI]:1.18-6.00). Although not statistically significant after multiple comparisons adjustment, time to first outdoor fall appeared to differ between the four dose groups (unadjusted p for overall difference = 0.013; adjusted p = 0.222), with risk of a first-time outdoor fall 39% lower in the 1000 IU/day group (HR = 0.61; 95% CI: 0.38-0.97; unadjusted p = 0.036; adjusted p = 0.222) and 40% lower in the 2000 IU/day group (HR = 0.60; 95%CI 0.38-0.97; p = 0.037; adjusted p = 0.222), each versus control. CONCLUSION: Vitamin D supplementation doses ≥1000 IU/day might have differential effects on fall risk based on fall location and fracture risk, with the most robust finding that vitamin D doses between 1000 and 4000 IU/day might increase the risk of first time falls with fractures. Replication is warranted, given the possibility of type 1 error.
BACKGROUND/ OBJECTIVES: To assess whether vitamin D supplementation prevents specific fall subtypes and sequelae (e.g., fracture). DESIGN: Secondary analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You)-a response-adaptive, randomized clinical trial. SETTING: Two community-based research units. PARTICIPANTS: Six hundred and eighty-eight participants ≥70 years old with elevated fall risk and baseline serum 25-hydroxyvitamin D levels of 10-29 ng/ml. INTERVENTION: 200 IU/day (control), 1000 IU/day, 2000 IU/day, or 4000 IU/day of vitamin D3. MEASUREMENTS: Outcomes included repeat falls and falls that were consequential, were injurious, resulted in emergency care, resulted in fracture, and occurred either indoors or outdoors. RESULTS: After adjustment for multiple comparisons, the risk of fall-related fracture was greater in the pooled higher doses (≥1000 IU/day) group compared with the control (hazard ratio [HR] = 2.66; 95% confidence interval [CI]:1.18-6.00). Although not statistically significant after multiple comparisons adjustment, time to first outdoor fall appeared to differ between the four dose groups (unadjusted p for overall difference = 0.013; adjusted p = 0.222), with risk of a first-time outdoor fall 39% lower in the 1000 IU/day group (HR = 0.61; 95% CI: 0.38-0.97; unadjusted p = 0.036; adjusted p = 0.222) and 40% lower in the 2000 IU/day group (HR = 0.60; 95%CI 0.38-0.97; p = 0.037; adjusted p = 0.222), each versus control. CONCLUSION: Vitamin D supplementation doses ≥1000 IU/day might have differential effects on fall risk based on fall location and fracture risk, with the most robust finding that vitamin D doses between 1000 and 4000 IU/day might increase the risk of first time falls with fractures. Replication is warranted, given the possibility of type 1 error.
Authors: Marcela Davalos-Bichara; Frank R Lin; John P Carey; Jeremy D Walston; Jennifer E Fairman; Michael C Schubert; Jeremy S Barron; Jennifer Hughes; Jennifer L Millar; Anne Spar; Kristy L Weber; Howard S Ying; Kathleen M Zackowski; David S Zee; Yuri Agrawal Journal: J Geriatr Phys Ther Date: 2013 Apr-Jun Impact factor: 3.381
Authors: Erin D Michos; Christine M Mitchell; Edgar R Miller; Alice L Sternberg; Stephen P Juraschek; Jennifer A Schrack; Sarah L Szanton; Jeremy D Walston; Rita R Kalyani; Timothy B Plante; Robert H Christenson; Dave Shade; James Tonascia; David L Roth; Lawrence J Appel Journal: Contemp Clin Trials Date: 2018-08-20 Impact factor: 2.226
Authors: Erin D Michos; Christine M Mitchell; Edgar R Miller; Alice L Sternberg; Stephen P Juraschek; Jennifer A Schrack; Sarah L Szanton; Jeremy D Walston; Rita R Kalyani; Timothy B Plante; Robert H Christenson; Dave Shade; James Tonascia; David L Roth; Lawrence J Appel Journal: Contemp Clin Trials Date: 2020-01-27 Impact factor: 2.226
Authors: Johanna Eronen; Mikaela B von Bonsdorff; Timo Törmäkangas; Merja Rantakokko; Erja Portegijs; Anne Viljanen; Taina Rantanen Journal: Prev Med Date: 2014-07-18 Impact factor: 4.018
Authors: Lauren A Burt; Emma O Billington; Marianne S Rose; Duncan A Raymond; David A Hanley; Steven K Boyd Journal: JAMA Date: 2019-08-27 Impact factor: 56.272
Authors: Adit A Ginde; Patrick Blatchford; Keith Breese; Lida Zarrabi; Sunny A Linnebur; Jeffrey I Wallace; Robert S Schwartz Journal: J Am Geriatr Soc Date: 2016-11-16 Impact factor: 5.562
Authors: S Takeda; T Yoshizawa; Y Nagai; H Yamato; S Fukumoto; K Sekine; S Kato; T Matsumoto; T Fujita Journal: Endocrinology Date: 1999-02 Impact factor: 4.736
Authors: Michael Schwenk; Andreas Lauenroth; Christian Stock; Raquel Rodriguez Moreno; Peter Oster; Gretl McHugh; Chris Todd; Klaus Hauer Journal: BMC Med Res Methodol Date: 2012-04-17 Impact factor: 4.615
Authors: Erin D Michos; Rita R Kalyani; Amanda L Blackford; Alice L Sternberg; Christine M Mitchell; Stephen P Juraschek; Jennifer A Schrack; Amal A Wanigatunga; David L Roth; Robert H Christenson; Edgar R Miller; Lawrence J Appel Journal: J Endocr Soc Date: 2022-04-16
Authors: Yurun Cai; Amal A Wanigatunga; Christine M Mitchell; Jacek K Urbanek; Edgar R Miller; Stephen P Juraschek; Erin D Michos; Rita R Kalyani; David L Roth; Lawrence J Appel; Jennifer A Schrack Journal: BMC Geriatr Date: 2022-04-10 Impact factor: 3.921